Sexual Health for Sex Workers who Engage in Street-Level Prostitution

Sex work and the use of drugs are indistinguishably connected, and both bring substantial risks to health. Commercial sex workers are a socially marginalized group of people with low health standards. They have limited routine healthcare, and they only attend outreach services when their health derails their capacity to sell sex. Street-level prostitutes are at a high risk of acquiring sexually transmitted diseases. The use of condoms lowers the risk, but the protective measures’ utilization is inconsistent as clients ask for unprotected sex for more money (Benoit et al., 2018). Sexual health for a sex worker who takes part in street-level prostitution includes access to information and education, health consultation, as well as HIV testing and treatment. Other areas are SRH services and strengthening partnerships with community organizations.

Information and Education

Sex workers should understand their body and sexuality, the best way of negotiating sexual services, and accessing health services. Moreover, support systems are bedrocks of sexual health among street-level sex workers (Benoit et al., 2018). Sex work projects should utilize a diverse combination of strategies to raise sexual health awareness. Yuliza et al. (2019) showed that among the factors that influence the prevention of HIV/AIDS behavior among Female Sex Workers was education and knowledge. Their study showed a significant correlation between education and prevention of HIV/AIDS behaviors. The outcome of the study was in line with the findings of Ashariani et al. (2016), who stated that there exists a significant relationship between knowledge and the use of condoms in the prevention of sexually transmitted infections. Yuliza et al. (2019) demonstrated that the higher the level of education, the more likely they are to take action towards the prevention of HIV/AIDS. Education thus relates an individual’s ability to obtain and respond to provided information. Sex workers should thus be given information and education to be empowered for better negotiation and knowledge on how to access health services.

Health Consultant

Sex workers should understand diverse types of sex, negotiate with clients, receive condoms, and medical help. Health information should be beyond the best prevention of sexually transmitted illnesses (Brookfield et al., 2020). It should entail issues such as contraception, abortion, drug use, hepatitis, and transgender persons. Other fundamental problems are legal subjects, financial management, civil rights, and self-defense. However, sex workers experience health challenges. Fear of authorities, stigma, and disordered living patterns can be serious hindrances for them to access healthcare. Sexual workers are at a high risk of health issues, including chronic illnesses like back pain and diabetes, sexually transmitted diseases, alcohol and drug dependency disorders, and mental illness (Ghimire & Teijlingen, 2009). Ghimire and Teijlingen (2009) in their study, showed that one-fifth of Female Sex Workers (FSWs) had never sought healthcare services. Most FSWs visited private clinics and non-governmental organizations clinics, as well as pharmacies for their treatment. Both service and personal-related factors acted as significant hindrances in access to healthcare services (Ghimire & Teijlingen, 2009). Discrimination, lack of confidentiality, and harmful attitude by health workers, fear of being exposed to the community as a sex worker, and poor communication were the key hindrances in searching for sexual health care (Ghimire & Teijlingen, 2009). It is evident that FSWs are willing to seek health care services from health providers who assure them of their confidentiality and privacy. It is thus important to tackle a common biased attitude among health care providers, particularly towards FSWs.

HIV Testing and Treatment

There are high STI rates among street-level sex workers in the US and different parts of the world. The majorities of sex workers rarely go for HIV testing and do not know their status. Low willingness to go for testing and concerns about testing confidentiality were primary barriers to sexual health. Sex workers should receive HIV testing every six months (Benoit et al., 2018). Likewise, healthcare practitioners conducting HIV testing should follow them with preventive practices. They should inform street-level sexual workers to use contraceptives, which protect them against STIs. The findings of a study by Surratt et al. (2014) indicated that street-based FSWs are faced with a wide range of considerable challenges to testing and treatment of HIV. Mainly, regarding this, are the structural aspects of HIV-associated stigma, inadequate support system, instability in housing, and limitations of accessing services. Surratt et al. (2014) argued that such structural hindrances seemed to be persistent in the targeted population’s environmental background, influencing to some extent the uptake of HIV testing and restraining seeking treatment among HIV- infected sex workers to a higher degree.

Of special interest is that people with high perceived HIV infection risk are less likely to have recent tests than others with low risk of HIV infection (Surratt et al., 2014). That seems to be confirmation that fear of HIV diagnosis is common among FSWs and is in line with qualitative data showing denial as a prevailing factor that adversely impacts uptake to HIV testing (Surratt et al., 2014). Understanding and alleviating these barriers in the future through structural and behavioral intervention will be important to the effective rolling out of biomedical preventive plan among the highly susceptible populations such as FSWs.

Sexual Reproductive Health (SRH) Services

Sex workers should access and utilize SRH services, for instance, pregnancy termination pills and contraception. Hormonal contraception, such as Depo-Provera injectable, control pills, and implants, are significant in sexual health programs. UNHCR and UNFPA provide policies and programs for supporting SRH services to street-level sex workers in emergency settings (Brookfield et al., 2020). Moreover, UNFPA and UNHCR made manuals specific to humanitarian platforms, which act as guidelines for SRH services.

SRH services are still inaccessible by the majority of sex workers. Lafort et al. (2017) established that lack or inadequacy of SRH services and referral issues, such as unsustainable referral provision, money charged at referral centers, and unknown referral centers, were the key obstacles to accessing and using SRH care. These findings could help policymakers and program implementers take the required steps to reduce or eliminate these obstacles in the health care system that hinder sex workers from obtaining SHR services.

Strengthening Partnerships and Expanding Choices

Partnerships at the country, community, and local levels removed obstacles sex workers faced while enjoying human rights. Effective programs on sex work and HIV promoted and supported local partnerships and coordinated structures. Policies and programs for educating and training sex workers should align with right-based plans (Benoit et al., 2018). Healthcare professionals should direct culturally sensitive topics to opinion front-runners and law prosecution agencies. Community efforts need to strengthen and monitor laws and supportive policies developed for street-level sex workers. Community organizations focused on sex workers, and health professionals should facilitate the delivery of evidence-based health services.

Studies investigating the success of sex workers’ health promotion emphasize the significance of responses that empower the community, prioritizing the involvement of the targeted population in creating and implementing programs (Varcoe & Dick, 2008). Community empowerment interventions promote the community’s mobilization and important awareness among sex workers to change relationships (Benoit et al., 2017). Effective population empowerment processes entail peer-to-peer involvement in which sex workers become dedicated instructors of their managers, intimate partners, and colleagues.

Benoit et al. (2017) analysis of a pilot program of peer health education established five themes. The findings of their analysis established the pilot program resulted in decreased internalized shame and raised self-worth in the subjects. The subjects’ important awareness increased regarding the problems of diversity in gender identity, sexual orientation, cultural background, and work exposures. Benoit et al. (2017) showed that the program participants acquired information on how sex shame is perpetuated and enacted. Besides, they became more at ease fighting stigmatization, including that from frontline service providers. The analysis is proof that peer education programs can help improve the community empowerment of sex workers.

Conclusion

In summary, sex workers should comprehend their body and sexuality, the preeminent way of discussing sexual services, and access health services. Similarly, the healthcare consultants steering HIV testing among sex workers should follow them with preventive practices. Lastly, UNHCR and UNFPA should deliver policies and programs for offering SRH services to street-level sex workers in critical situations. Community empowerment is one of the ways of strengthening and increasing the choices of sex workers.

References

Ashariani, S. (2016). Factors Associated with Condom Use in Women Sexual Workers for the Prevention of Sexually Transmitted Infections in the Mentari Clinic in the Panjang Bandar Lampung Health Center. Lampung: Lampung University.

Benoit, C., Belle-Isle, L., Smith, M., Phillips, R., Shumka, L., Atchison, C., Jansson, M. Flagg, J. (2017). Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program. International Journal for Equity in Health, 16, 1.

Benoit, C., Jansson, S. M., Smith, M., & Flagg, J. (2018). Prostitution stigma and its effect on the working conditions, personal lives, and health of sex workers. The Journal of Sex Research, 55(4-5), 457-471.

Brookfield, S., Dean, J., Forrest, C., Jones, J., & Fitzgerald, L. (2020). Barriers to accessing sexual health services for transgender and male sex workers: A systematic qualitative meta-summary. AIDS and Behavior, 24(3), 682-696.

Ghimire, L., & Teijlingen, E. V. (2009). Barriers to Utilisation of Sexual Health Services by Female Sex Workers in Nepal. Global Journal of Health Science, 1, 1.

Lafort, Y., Greener, R., Roy, A., Greener, L., Ombidi, W., Lessitala, F., Skordis-Worrall, J., … Delva, W. (2017). Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa. Reproductive Health, 14, 1.

Surratt, H. L., O’Grady, C. L., Kurtz, S. P., Buttram, M. E., & Levi-Minzi, M. A. (2014). HIV Testing and Engagement in Care among Highly Vulnerable Female Sex Workers: Implications for Treatment as Prevention Models. Journal of Health Care for the Poor and Underserved, 25, 3, 1360-1378.

Varcoe C, & Dick S. (2008). The intersecting risks of violence and HIV for rural aboriginal women in a neo-colonial Canadian context. Journal of Aboriginal Health, 4, 42–52.

Yuliza et al. (2019). Factors Related to HIV/AIDS Prevention Behavior Among Female Sex Workers in Padang in 2018. Journal of Medicine and Health, 10, 1, 18-25